Small Cell Carcinoma of the Gallbladder: A Case Report and Review of the Literature

Case Presentation:

Small Cell Carcinoma of the gallbladder is a rare aggressive malignancy with only 74 cases documented in the literature so far [1].We present a case of a 69 yr old lady who was diagnosed with small cell carcinoma of the gallbladder with liver metastasis and is currently undergoing chemotherapy.

A 69 year old lady presented with a four day history of worsening right upper quadrant pain, worse on inspiration and associated chills and night sweats. Of note, the patient has had early satiety for the last two weeks prior to her admission. Laboratory investigations were normal on presentation. An Ultrasound of the abdomen and subsequent CT Abdomen revealed cholelithiasis, thickening of the gallbladder wall extending to the left hepatic lobe with a 10 cm by 8.5 cm lesion in the left hepatic lobe and portacaval lymph node involvement. Ultrasound guided fine needle aspiration of the hepatic lobe mass revealed small cell carcinoma staining weakly with Cam5.2, synaptophysin, chromogranin and TTF‐1. The patient was treated with one cycle of cisplatin and etoposide which was then changed to carboplatin and etoposide due to severe myelosuppression. Follow‐up CT Abdomen showed progression of the disease. The patient unfortunately passed away a month later.

Discussion:

Seven thousand cases of gallbladder carcinoma are seen annually in the United States [5]. Ninety Percent of cholangiocarcinomas are adenocarcinoma [2]. Less than one percent of gallbladder carcinoma cases are small cell carcinomas [2]. The median age is 67 years old and is twice more common in female population [1]. It often presents at an advanced stage due to lack of systemic symptoms. The median survival is nine months [2]. Paraneoplastic endocrine manifestations include hypercalcemia, cushings syndrome and hyponatremia [3] . The modailities of treatment include resection, chemotherapy or a combination of resection and adjuvant chemotherapy. Patients who underwent surgery followed by chemotherapy and radiation treatment have the longest median survival [4]. However due to late presentation and extensive disease, many patients are not surgical candidates and platinum based chemotherapy and etoposide is the mainstay of treatment in these patients [4].

Conclusions:

Small Cell Carcinoma of the gallbladder is a rare aggressive malignancy with only 74 cases documented in the literature so far [1]. The median age of occurrence is 67 years old and is twice more common in the female population [1]. Cholelithiasis and smoking are risk factors for gallbladder carcinoma. Chemotherapy remains the mainstay of treatment.

References:

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Moskal TL, Zhang PJ, Nava HR. Small cell carcinoma of the gallbladder.J Surical Oncology 1999 Jan;70(1):54‐9.

Ng ES, Venkateswaran K, Ganpathi SI, Chuah BY. Small Cell Gallbladder Carcinoma Complicated by Paraneoplastic Hyponatremia : A Case Report and Literature Review. Journal Gastrointestinal Cancer . 2010 Dec; 41(4):264‐8.

Usmani S, Pazooki M, Bilgrami SF. Small cell carcinoma of the gall bladder. Role of adjuvant chemotherapy. Journal Gastrointestinal Cancer. 2010 Mar;41(1):84‐7.

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